Optimal Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease and Left Ventricular Dysfunction

Background: Data on clinical outcomes after intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients with multivessel disease and left ventricular (LV) dysfunction are scarce. Methods and Results: The OPTIVUS-Complex PCI study multivessel cohort was a prospective multicenter single-arm trial enrolling 1,010 patients undergoing multivessel IVUS-guided PCI including left anterior descending coronary artery target with an intention to meet the prespecified OPTIVUS criteria for optimal stent expansion. We compared clinical outcomes between patients with and without LV dysfunction. The primary endpoint was a composite of death, myocardial infarction, stroke, any coronary revascularization, or hospitalization for heart failure. There were 763 patients (75.5%) with preserved LV function (LV ejection fraction [LVEF] >50%), 176 patients (17.4%) with moderate LV dysfunction (3550%), and 71 patients (7.0%) with severe LV dysfunction (LVEF <= 35%). The cumulative 1-year incidence of the primary endpoint was 9.5%, 18.9%, and 17.1%, respectively, in patients with preserved LV function, moderate LV dysfunction, and severe LV dysfunction (log-rank P<0.001). After adjusting confounders, there was a significantly higher risk of moderate LV dysfunction and a numerically higher risk of severe LV dysfunction relative to preserved LV function for the primary endpoint (hazard ratio (HR), 1.71; 95% confidence interval (CI), 1.08-2.71; P=0.02; and HR, 1.52; 95% CI, 0.77-2.97; P=0.23). Conclusions: Among patients undergoing multivessel IVUS-guided PCI with contemporary practice, 1-year clinical outcomes were worse in patients with LV dysfunction.